Disaster behavioral health and its integration into disaster public health preparedness and response

Disaster Behavioral Health as a comprehensive discipline including policy, service delivery, evaluation and research is less than thirty years old. While the U.S. government has responded to disasters since 1803, it was the massive disasters in the 1960's that lead to the Federal Disaster Assistance Administration legislation which then became the Federal Emergency Management Agency (FEMA) in 1979. Medical care by the public health sector has always been a major component of disaster response as death and injury is of primary concern. Disaster behavioral health was included in the national response plan in 1974 when the Crisis Counseling Assistance and Training Program was initiated, but the American Red Cross did not formally integrate mental health into their training curriculum until 1989. The past decade of catastrophic events and the rise in natural disasters exemplifies the necessity of addressing preparedness and response activities from the public health perspective. Collaborative planning across public health, mental health, substance abuse and emergency services organizations that includes exercising broad scale public education, risk communications and crisis intervention improves the timeliness organization and efficiency of responses to disasters. Public health and behavioral health disciplines continue to work at integrating their missions, planning and response activities into a seamless delivery system to survivors and their communities across the nation as can be observed in the new federal disaster behavioral health Concept of Operations (HHS, 2011) but there is still much learning that needs to take place from history and from each of the response organizations involved.